East Texas Medical Alliance LLP
Organization Active NPI Pediatrics Physician · Palestine, TX
NPI 1003935172 · NPPES record last updated Dec 2, 2011
Key facts
- NPI
- 1003935172
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Pediatrics Physician 208000000X
- Legal business name
- EAST TEXAS MEDICAL ALLIANCE LLP
- Practice address
- 111 Medical Drive
Palestine, TX 75801-4781 - Phone
- (903) 723-8554
- Fax
- (903) 723-2054
- NPI assigned
- Mar 28, 2007
- Organization subpart
- No
Authorized official
- Name
- Dr. Robert Gene Blackwell, M.D.
- Title
- Managing Partner
- Phone
- (903) 723-8554
Practitioners 12
-
Robert G Blackwell, M.D.
-
Stephen J Bates, M.D.
-
Melinda A Duncan, D.O.
-
Matthew James Isom, M.D.
-
Frank Dwayne Setzler Jr., D.O.
-
Charles Glenn Dundas, M.D.
-
Gary Mark Parkhurst, M.D.
-
David M. Squicquero, M.D.
National Provider Directory
Locations
2000 S Loop 256
#120
Palestine, TX 75801
Phone (903) 731-9300
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Obstetrics & Gynecology Physician |
207V00000X | |||
| Otolaryngology Physician |
207Y00000X | |||
| Pediatrics Physician |
208000000X | Yes |
Addresses
Primary practice location
111 Medical Drive
Palestine, TX 75801-4781
Mailing address
115 Medical Drive
Palestine, TX 75801-4781
Phone (903) 723-8554
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 00R18C | Other | TX | BLUE CROSS GROUP NUMBER |
| 111610501 | Medicaid | TX | |
| 111610503 | Other | TX | EPSDT GROUP NUMBER |
| CQ2287 | Other | TX | RR MEDICARE NUMBER |
Other names
- First MedChoice
Other providers in Palestine, TX
- Frank J Duncan
- Melinda A Duncan
- Richard Lee Dutton
- Hailey Dyer
- East Texas Family Medicine PA
- East Texas Physcian'S Alliance
- East Texas Physician Allicance
- East Texas Physician'S Alliance, LLP
- East Texas Physician'S Alliance, LLP
- East Texas Physicians Alliance
All providers in Palestine, TX · Pediatrics Physician in Texas
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Dec 2, 2011. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.